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The Blueprint for Putting Patients at the
Center of APIs
Session #INV5, February 11, 2019
Aneesh Chopra, President, CareJourney
Shannon Sartin, Executive Director, Digital Services, HHS
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Aneesh Chopra, President, CareJourney
Shannon Sartin, Executive Director, Digital Services, HHS
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Welcome & Introductions
• Aneesh Chopra Opening Remarks
• Discussion with Shannon Sartin, Executive Director, Digital
Services, HHS
Agenda
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• Discuss how you can support and encourage broad adoption of
openly accessible APIs to rapidly advance the ability for consumers
and their authorized caregivers to easily get, use, and share digital
health information when, where, and how they want it
• Identify the business case for implementing consumer APIs and
leveraging them to expand the reach of your organization
• Prepare your organization for policy implications around consumer
controlled APIs—get up to speed on what's required and get started
with a plan to meet those requirements
• Describe how to leverage standards and safeguards to support
patient access, while preserving privacy, security, and patient
preferences
• Explore ways to promote better electronic access to a consumer’s
clinical and payment information via third party applications by
engaging with startups and developers
Learning Objectives
Source: https://support.apple.com/en-us/HT208647 ONC
Milestone: Compliance to Voluntary
Objective Performance Exclusion
E-copy of health
information
93% 54%
E-copy of discharge
instructions
93% 53%
Blueprint for Patient-Centered APIs
Source: whitehouse.gov/innovation
APIs as enabling (digital)
infrastructure
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Open up more data
3 “Standards-first” implementation
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Build “retail” and “wholesale” digital
services
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”Hug” organizations signing
outcomes contracts
Source: http://www.pge.com/en/myhome/addservices/sharemydata/customers/index.page; mint.com; https://www.jpmorganchase.com/corporate/investor-
relations/document/ar2015-ceolettershareholders.pdf
"In the future, instead of giving a third party unlimited access…we hope to build
systems that allow us to “push” information – and only that information agreed to by
the customer – to that third party.”
- Jamie Dimon, 2015 Shareholder Letter
APIs as Enabling (Digital) Infrastructure
Source: Roku; HL7 Argonaut Project
Open up More Data (“A Roku Moment”)
Patient name
Sex
Date of birth
Race
Ethnicity
Preferred language
Smoking status
Problems
Medications
Medication allergies
Laboratory tests
Laboratory results
Vital signs
Procedures
Care team members
Immunizations
Unique Device identifiers
Assessment and Plan of Treatment
Goals
Health concerns
2015 Edition
Common Clinical Data Set
CMS requires API-access for consumer-designated apps
by 10/1/19 (90-day reporting period); is your API
gateway “open” or “closed”? Can you add more clinical
content (FHIR resources) at the pace of industry
consensus?
Open Notes Imaging
Interactive
Care Plan
Discharge
Notification
Net Pricing
(Network
Status)
Cancer
Data Set
Common
Clinical
Data Set
Source: Https://cloudblogs.microsoft.com/industry-blog/industry/health/microsoft-amazon-google-and-ibm-issue-joint-statement-for-healthcare-interoperability/; https://www.healthit.gov/buzz-blog/interoperability/heat-wave-the-u-s-is-poised-to-catch-
fhir-in-2019/
ONC reports 82% of hospitals, 64% of physicians met 2015 CERT edition API
requirements using EHRs deploying FHIR standards
Standards-First Implementation
Argonaut FHIR API Standards Road Map
Current Initiatives
• Clinical Notes for patient and
practitioner uses (2/19 exp)
• Bulk Data Access: Flat FHIR
(2/19 exp)
• CDS Hooks IG (Ballot 5/18)
• “Simple Assessment”
Questionnaire (2/19 exp)
• Questionnaire Response
• Interchange of simple forms
2019 Priorities
(Selection Process)
• Clinical Data Subscriptions
(enables “push” use cases)
• Update to FHIR R4 (Notes,
Encounters, select “write”
services)
• SMART web messaging +
CDS Hooks (radiology
orders)
• Provenance (data integrity)
Implementation Guides
• SMART App Authorization
• Data Query IG
• Provider Directory IG
• Scheduling IG (3/18)
Source: https://github.com/smart-on-fhir/fhir-bulk-data-docs; https://www.healthaffairs.org/do/10.1377/hblog20180618.138568/full/
CMS Embraces “Bulk Access” to Claims
“ONC also supports the ongoing work to extend this open API technology to population-
level data transfer…Central to a value-based health system is expanding the ability to find
and move data for more than one patient at a time.”
-ONC Director Don Rucker
CMS calls on MA plans to “meet or exceed” Blue Button FHIR
API by CY2020, considering regulation; Rush UMC launching
one of the inaugural “Blue Button” apps to aid consumers in
navigating care delivery options
MyMedicare.gov: “Retail” And “Wholesale”
Gap: ADT Feed +
Scheduling
Gap: Care Plan open data
standard
Gap: Clinical Data Set +
Supplier Database
eMedicare & Consumer Decision Support
PCPs must contact patients within 48 hours of
discharge; visit within 2 weeks; explain discharge
instructions, perform medication reconciliation
TCM Rate, By ACO (2017 Data)
Source: Bindman AB, Cox DF. Changes in Health Care Costs and Mortality Associated With Transitional Care Management Services After a Discharge Among Medicare Beneficiaries. JAMA Intern Med. 2018;178(9):1165–1171.
doi:10.1001/jamainternmed.2018.2572; CareJourney analysis of CMS “VRDC”
Gretsky’s Puck Heading for Risk Contracts
$3,358
$3,033
$2,000
$2,500
$3,000
$3,500
Post-Discharge Spend,
31-60 Days After Eligible
Discharge
No TCM
1.6%
1.0%
0.0%
0.5%
1.0%
1.5%
2.0%
Post-Discharge Mortality
Rate,
31-60 Days After Eligible
Discharge
No TCM
The Impact of Transitional Care Management (TCM) Services
N =
18,756,707
P < .001
N =
18,756,707
P < .001
9.7%
decrease in
spend
0.6%
decrease in
mortality
Source: Commonwealth Fund; https://www.whitehouse.gov/sites/default/files/docs/cea_coi_report_final.pdf
Apps for Health Information
Fiduciaries
“Savers receiving conflicted advice earn returns roughly 1% lower each year… we
estimate the aggregate annual cost of conflicted advice is about $17 billion each year”
- Obama Council of Economic Advisors
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Questions ?
Aneesh Chopra
President, CareJourney
@aneeshchopra
Shannon Sartin
Executive Director, Digital Services, HHS
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